Friday, March 25, 2011

Is India's National Rural Health Mission a "fiasco"?

In a report tabled in parliament on Thursday, India's Public Accounts Committee (PAC) Chairman, Dr. Murli Manohar Joshi has called for a complete re-appraisal and re-design of the six year old central government flagship social scheme, National Rural Health Mission (NRHM).  Dubbing the scheme a "fiasco", the report cited multiple findings of untrained personnel, substandard conditions, misuse of government property and ineffective or non-existent monitoring and review mechanisms.

Source: Topnews

Established in 2005 and focused on 18 states, the NRHM goals include increasing access to public health infrastructure and services, improving infant and maternal mortality rates, prevention and control of diseases, and encouraging alternative lifestyles and systems of medicine.

At the 5 year mark, a mid point review struck an encouraging tone, advising tighter implementation practices, better supervision and greater civil society participation and local governance.  The fourth and most recent common review mission report highlights gaps state-wise in financial management and program management, infrastructure and personnel issues and decentralized planning. Independent health experts echo these concerns.

Perhaps the most damning critique of NRHM is that at 1.1% of GDP, the scheme falls woefully short of public health expenditure targets set at 2-3% and does little to boost India's global ranking on healthcare expenditure, placed fourth from the bottom in a 2007-8 study by the World Health Organization.

It became fashionable in global aid circles in the past decade, to champion the entry of large international private philanthropy foundations that seek to infuse new resources, energy, and ideas.  But now that such entities have finally learned to stop importing highly paid staff big on enthusiasm and short on results, the onus switches back to the locals to build a better life for ourselves.  Of course, your dollars are still welcome here.


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